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High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients.
J Thromb Haemost. 2020 07; 18(7):1743-1746.JT

Abstract

BACKGROUND

Coagulopathy is a common abnormality in patients with COVID-19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID-19 patients.

OBJECTIVES

Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID-19 patients.

PATIENTS AND METHODS

We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID-19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.

RESULTS

From March 19 to April 11, 2020, 26 consecutive patients with severe COVID-19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID-19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.

CONCLUSION

Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID-19 patients.

Authors+Show Affiliations

Institut Cochin, 3i Department, Team "Pulmonary & Systemic Immune Responses During Acute and Chronic Bacterial Infections", Paris, France.Service de Réanimation, Soins Continus, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France.Service de Réanimation, Soins Continus, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France.Service de Réanimation, Centre Hospitalier Intercommunal Alençon Mamers, Alençon, France.Service de Réanimation, Soins Continus, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France.Service de Réanimation, Soins Continus, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France.Service de Réanimation, Centre Hospitalier Intercommunal Alençon Mamers, Alençon, France.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32320517

Citation

Llitjos, Jean-François, et al. "High Incidence of Venous Thromboembolic Events in Anticoagulated Severe COVID-19 Patients." Journal of Thrombosis and Haemostasis : JTH, vol. 18, no. 7, 2020, pp. 1743-1746.
Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020;18(7):1743-1746.
Llitjos, J. F., Leclerc, M., Chochois, C., Monsallier, J. M., Ramakers, M., Auvray, M., & Merouani, K. (2020). High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. Journal of Thrombosis and Haemostasis : JTH, 18(7), 1743-1746. https://doi.org/10.1111/jth.14869
Llitjos JF, et al. High Incidence of Venous Thromboembolic Events in Anticoagulated Severe COVID-19 Patients. J Thromb Haemost. 2020;18(7):1743-1746. PubMed PMID: 32320517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. AU - Llitjos,Jean-François, AU - Leclerc,Maxime, AU - Chochois,Camille, AU - Monsallier,Jean-Michel, AU - Ramakers,Michel, AU - Auvray,Malika, AU - Merouani,Karim, Y1 - 2020/05/27/ PY - 2020/04/20/received PY - 2020/04/20/accepted PY - 2020/4/23/pubmed PY - 2020/7/16/medline PY - 2020/4/23/entrez KW - COVID-19 KW - SARS-CoV-2 KW - anticoagulation KW - critical care KW - pulmonary embolism KW - venous thromboembolism SP - 1743 EP - 1746 JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost VL - 18 IS - 7 N2 - BACKGROUND: Coagulopathy is a common abnormality in patients with COVID-19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID-19 patients. OBJECTIVES: Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID-19 patients. PATIENTS AND METHODS: We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID-19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration. RESULTS: From March 19 to April 11, 2020, 26 consecutive patients with severe COVID-19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID-19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms. CONCLUSION: Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID-19 patients. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/32320517/High_incidence_of_venous_thromboembolic_events_in_anticoagulated_severe_COVID_19_patients_ L2 - https://doi.org/10.1111/jth.14869 DB - PRIME DP - Unbound Medicine ER -